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5 African American Use of Residential Care in North Carolina Elizabeth J. Mutran, Ph.D., S. Sudha, Ph.D., Peter S. Reed, M.P.H., Manoj Menon, M.P.H., and Tejas Desai, M.S. Little is known regarding the use of long-term-care facilities by African Americans other than a few simple facts. First, it is well documented that African Americans use nursing homes less than whites (Belgrave, Wykle & Choi, 1993; Greene & Ondrich, 1990; Hing, 1987; Kemper & Murtaugh , 1991; Mui & Burnette, 1994; Salive et al., 1993; Smith, 1993; Wallace et al., 1997). Second, this lower use of nursing facilities by minorities is not the result of a lower need for care. Several studies have found that despite greater disability, elderly African Americans were placed in nursing homes at between one-half and three-quarters the rate of elderly whites, and that they underused services that could improve quality of care (Belgrave, Wykle & Choi, 1993; Greene & Ondrich, 1990; Hing, 1987; Smith, 1993). Mui and Burnette (1994) wrote that whereas whites used more in-home and nursing home services, minorities used more informal helpers. Wallace and colleagues reported similar findings in 1997, demonstrating that African American frail adults with three to five dependencies in activities of daily living were more likely to use unpaid home care or no care than were whites with the same dependency level. They also found that only one-third of African Americans with such limitations were in nursing homes, while more than one-half of whites with similar limitations were using such facilities. Unpaid home care was the sole source of assistance for approximately 45 percent of African Americans who needed care, with less than one-third of whites using only unpaid help. In addition, it is known that a change in usage is occurring. For the past few decades, the African American rate of long-term-care use has been gradually converging with that of whites. Burr (1990) suggests that this may be due to increased African American participation in government programs such as Medicaid and Medicare. According to the National Center for Health Statistics (Brooks, 1996), the concentration of African Americans in skilled nursing facilities has been steadily increasing , growing 65 percent from 1974 to 1985, whereas white use appears stable. Though white seniors of both sexes have higher rates of institutionalization , evidence suggests that use by African American men and women is increasing relative to their white counterparts (Burr, 1990). If this trend is witnessed in skilled nursing facilities, what can be said about African American use of residential care? This is a system of care that serves populations unable to live in a completely independent manner , who need help with personal care but are not in need of skilled services . Rates of institutionalized care utilized by the U.S. Census to assess use sometimes blur the distinction between types of homes (Pynoos & Golant, 1996), but residential care facilities are indeed distinct types of living arrangements. The type of housing called “board and care” (also known as adult-care homes, domiciliary care homes, small congregate homes, or shared housing) forms one specific and rapidly growing segment of these alternate facilities. North Carolina has more than the national average number of these facilities and has fewer than the average number of nursing homes, with a distinctive reliance on the former as a substitute for the latter (Bolda, 1991). North Carolina refers to these facilities as adult care. Homes with less than seven residents are designated as family care homes, and larger homes are termed homes for the aged. They offer congregate meals and generally shared rooms. At the time the data presented in this chapter were collected (1994), neither Medicare nor Medicaid paid for residents of these homes, although some assistance was available from a state fund for the medically needy. Little is known about racial differences in the use of such homes. One recent study compared small board-and-care homes that provided a familial care setting in Cleveland and Baltimore (Morgan, Eckert & Lyon, 1995). The study found that the facilities differed by the race of the operator . Homes that were owned and operated by African Americans were smaller, had more shared space, charged lower fees, and had lower profits . They also tended to have a slightly more racially diverse clientele, although in general, homes served residents of a particular racial group, typically matching that of the operator. However, the study also found similarities across homes operated by African Americans and whites on key...

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